Monitoring fetal movements

 

INTRODUCTION

Maternal observation of fetal movement is comforting for pregnant women, while decreased fetal movement is a general cause for concern. Fetal activity can be noticed as early as 7-8 weeks of gestation with an ultrasound. Maternal perception of fetal movement usually starts in the second trimester, as early as 16-20 weeks. A gentle flutter is a typical description of a mother's first perception of fetal movement, which eventually becomes stronger, increases throughout the day, and peaks late at night.

A normal pattern (quality and quantity) of fetal movement practically ensures a well functional fetal system. When the fetal system is subjected to mild hypoxemia, which is a low concentration of oxygenated blood, decreased fetal movement is thought to correspond to a compensatory behavioral and physiological response, as blood flow is redistributed to essential organs. If hypoxemia is not resolved and is prolonged, it becomes more severe. Hence, compensatory responses may fail to protect the fetus, ultimately leading to injury or death.

Fetal injury or death could be prevented by early recognition of decreased fetal movement, which may provide an opportunity for identifying fetuses in distress who could benefit from an intervention, usually delivery. From a personal perspective, care providers have all the gadgets and tools to diagnose, but of what use are these instruments when it's too late and fetal demise has already occurred? Nothing supersedes motherly instincts; hence, maternal perception of fetal movement may be your earliest prognostic and diagnostic indicator.

KICK COUNTING

Kick counting refers to the minimum number of maternally perceived fetal movements consistent with fetal well-being, which is at least 10 fetal movements over a two hour period where the mother is at rest and focused. It is more than likely that 10 movements will be felt in less than two hours. In a research study, failure to meet these criteria prompted an intervention, which led to a threefold increase in interventions and reduction in fetal mortality. It is recommended that you start kick counting around the 7th month of pregnancy (approximately 28 weeks). Generally, babies are most active between bedtime and 1am. As you get to know your baby's movement pattern, you will be able to report any changes to your care provider. One can grow accustomed to getting 10 kicks in the same exact amount of time period every time kick counts are monitored. Nevertheless, there can be a broad array of time differences. The key is to notice substantial deviations from the overall pattern. 

HOW TO COUNT YOUR BABY'S MOVEMENTS?

1. Download any free kick counting application onto your phone, just search kick counter.

2. Choose a time of day when your baby is usually active and make sure you count around the same time on a daily basis. Consider counting after a meal or at bedtime.

3. Get in a comfortable position and place your hands on your belly. You may lie down on your side or recline in a chair. Sleeping on your back will cause the weight of your uterus to slow down the return of blood back to your heart, which essentially reduces the flow to the fetus, hence less oxygen and nutrients are being delivered.

4. Note the date and time that you begin counting your baby's movements.

5. Continue counting until your baby has achieved 10 kicks. Be sure to include any movements, including kicks, rolls, or flutters.

6. Record the end time on the downloaded application of your choice.

WHEN TO CALL YOUR CARE PROVIDER?   

  • If you have followed the above recommendation and have not felt 10 kicks by the end of the second hour, contact your care provider promptly. Most babies take less than 30 minutes to reach 10 movements, but all babies are different.
  • If you notice a significant discrepancy in the pattern over the course of a few days, contact your care provider.  For example, if it usually takes you 30 min to 1 hour to feel 10 kicks over the course of 4 days, and on the 5th day it takes you 2 hours or more, that is a substantial deviation.
     

REFERENCE: 

Frett, R. C. (April 2016).  Decreased fetal movement: diagnosis, evaluation, and management.  In C. J. Lockwood. (Ed.), Uptodate.  Retrieved from https://www-uptodate-com.ezproxy.med.nyu.edu/contents/decreased-fetal-movement-diagnosis-evaluation-and-management?source=search_result&search=kick+counts&selectedTitle=1%7E11